Action Points

Explain to interested patients that the American Heart Association advises adults to limit daily sodium intake to less than 2,300 milligrams, or about one teaspoon, but the average American consumes about 3,300 milligrams per day.

Explain to interested patients that most of the salt in the American diet comes from processed and restaurant foods, not the salt shaker.

Explain to interested patients that consuming too much salt has been purportedly associated with high blood pressure, stroke, heart attacks, kidney failure, and early death, although no direct population-wide causal links have been established.

Explain to interested patients that many public health advocates want the FDA to regulate and restrict the salt in processed foods.

COLLEGE PARK, Md., Nov. 30 -- The FDA should limit salt content in food and include a hypertension warning on salt's labeling, demanded sodium foes at a daylong public hearing.

Salt is currently on the FDA's so-called GRAS list -- generally regarded as safe.

But the Center for Science in the Public Interest and the American Medical Association both pressed the FDA to revoke the GRAS status, and the hearing was stacked with speakers pointing out the purported health hazards associated with salty diets.

The FDA was silent on its plans for salt, but Laura Tarantino, Ph.D., director of the FDA's food safety office, said that it was "really a good time to be having this meeting" because of increased research interest in salt and regulatory changes in other countries.

Yet the Salt Institute noted that there are no solid population-wide data showing how the health of the nation would benefit from a sharp reduction in sodium consumption.

"Trimming the salt content in processed and restaurant foods by half would save a minimum of 150,000 lives a year," countered Stephen Havas, M.D., M.P.H., vice president for science, quality, and public health at the AMA. Adults are consuming more than 4,000 mg of sodium a day, he said, almost double the AHA recommended amount of 2,300 mg, equal to one teaspoon of salt.

"The deaths attributed to excess salt consumption represent a huge toll -- the equivalent of a jumbo jet with more than 400 passengers crashing every day of the year, year after year," Dr. Havas said.

Dr. Havas, who testified at the hearing, said in an interview, "I'd like to see the FDA set strict limits on the amount of salt that is allowed in food and develop a better system of warning labels that would be placed on the front of food packaging so people will know what is in their foods."

Specifically, Dr. Havas proposed a red light, yellow light, green light system similar to the one used in Britain. "A green light on a package would indicate that the product is low salt, while red would mean it is high in salt," he explained. "This is very easy for people to understand."

This system would also encourage food manufacturers to reduce the salt in their products, because they won't want a red light on the front of the package, Dr. Havas said.

An AMA scientific statement supports a minimum 50% reduction in sodium in processed foods, fast food products, and restaurant meals to be achieved over the next decade.

The dangers of salt consumption are well recognized, asserted Michael F. Jacobson, of the Center for Science in the Public Interest. He said excess salt increases the risk of hypertension, stroke, kidney failure, heart attacks, and premature death.

He said the FDA could no longer back away from challenging food makers on sodium content because "it is increasingly hard for FDA officials to ignore the calls to action made in recent years by the medical community."

Jacobson cited the American Heart Association recommendation that adults limit daily sodium intake to less than 2,300 mg.

But the Salt Institute, an industry trade group, argued that labeling should not be changed without solid scientific evidence of the dangers of salt. Richard L. Hanneman, speaking for the group, said it would support a controlled trial to determine whether reducing salt consumption across a broad population would reduce the rate of hypertension, renal failure, and stroke.

"Let's do the study and find out the truth," he said. "This is an investment well worth making."

In testimony, Hanneman stated that correcting current deficiencies in potassium, calcium and magnesium by encouraging greater consumption of fruits, vegetables, whole grains, and dairy products would be more beneficial to public health.

That's all well and good, contended Dr. Havas, but specifically reducing salt can have a quick and powerful effect on health.

"Getting consumers to eat more fruit and vegetables is occurring at a glacial pace, but by [restricting] sodium we can do something very quickly," he said.

"The simplest thing to change and the one killing the most people is salt," Dr. Havas said. "Once we start reducing blood pressure, we can see an effect on stroke rate, heart disease rate and mortality within a year," he said.

Brian Kennedy, a spokesperson for the Grocery Manufacturers Association, based in the District of Columbia, said there was no need for a label change for salt "because it is an important ingredient in food and it's been in use for literally thousands of years and has important taste and functional properties."

Instead, the group pointed out that consumers have a broad range of foods containing no sodium or low sodium from which to choose.

Moreover, Kennedy said food companies have been very successful at making incremental reductions in salt levels in food products and processing and packaging technologies also allow for less salt or sodium.

The FDA gave no indication on when it would reach a decision.

Reviewed by Zalman S. Agus, MD Emeritus Professor University of Pennsylvania School of Medicine

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